Sec. 10.09.04.07. Payment Procedures

A. The provider shall submit his request for payment on the form designated by the Department.

B. The provider shall submit requests for payment for supplies on the same invoice which requests payment for the visit during which the supplies were used.

C. The Department reserves the right to return to the provider, before payment, all invoices not properly completed.

D. Payment Rates.

(1) The provider shall be paid the lesser of:

(a) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) The rate in accordance with the Department’s fee schedule.

(2) For out-of-State providers, rates shall be paid at the lower of the following:

(a) The home state's Medicaid rate for the same service rendered by the same provider if the provider participates in its home state Medicaid Program; or

(b) The rate paid for the same service rendered by a provider in the nearest Maryland county.

(3) The Department shall pay home health providers for medical and other supplies which are used during a covered home health visit as part of the treatment ordered by the recipient’s attending physician at a rate that is the lesser of the:

(a) Provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) Medicaid rate for the supply or pharmaceutical under COMAR 10.09.12 and 10.09.03.

(4) Effective January 1, 2010, subject to the limitations of the State budget, the fee schedule rates shall be adjusted annually by the same factor used by the Centers for Medicare and Medicaid Services in updating Medicare's prospective payment system rates. The annual fee schedule rate adjustment shall be limited to a maximum of 5 percent and be effective the date on which Medicare's rate changes are implemented.

E. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

F. The Department shall reimburse for supervision of home health aide services by a registered nurse as part of the home health aide reimbursement.

G. Payment to a provider of newborn early discharge services may not exceed the rate for one skilled nursing visit.

H. The Department shall reimburse for preauthorized home health services upon verification that a face-to-face encounter with the recipient was performed as described under Regulation .03C of this chapter.

I. The home health provider shall identify the individual who ordered the home health services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.